Distribution of background characteristics of assessed primary healthcare facilities in the Kagera Region (n=32)
A total of 32 primary healthcare facilities were studied from 4 border district councils, 26 (81%) of all health facilities were owned by the government, 5 (15.6%) were owned by FBO and 1(3.1%) was privately owned. Of 32 primary healthcare facilities, 27 (84.4%) were Dispensaries and 5 (15.6) were Health centres. Almost all health facilities 31(96.9%) visited were located in the village, and 18 (56.2%) health facilities were located 41 km away from district council headquarters, followed by 8 (25% ) primary healthcare facilities were located distance between 21km and 40 km, whereas 6 (18.8%) primary healthcare facilities were within 20 km from the district council headquarters (Table 2).
Table 2: Demographic characteristics of assessed primary healthcare facilities in four district councils of the Kagera Region, (n=32)
Variable
|
Frequency (n)
|
Percentage (%)
|
District councils
|
|
|
D1
|
7
|
21.9
|
D2
|
8
|
25
|
D3
|
6
|
18.8
|
D4
|
11
|
34.4
|
Ownership
|
|
|
Government
|
26
|
81.3
|
Private
|
1
|
3.1
|
Fbo
|
5
|
15.6
|
Location
|
|
|
Town
|
1
|
3.1
|
Village
|
31
|
96.9
|
Facility type
|
|
|
Dispensary
|
27
|
84.4
|
Health
|
5
|
15.6
|
Distance to council headquarters
|
|
|
<20 km
|
6
|
18.8
|
21-40
|
8
|
25
|
41 km and above
|
18
|
56.3
|
NB: Data presented in frequency and percentage, D= stand for the district involved.
Proportional of primary healthcare facilities response on immunization services readiness items in border district councils of the Kagera Region (n=32)
This study revealed that all the primary healthcare facilities visited had a functional refrigerator, reliable power source and the temperature performance chart last month before the day of data collection. The refrigerator temperatures were recorded and found to be within the stipulated standards of between - 20C and 80C, for vaccines and immunization services. About 97% of primary healthcare facilities had vaccine carriers and filled summary forms. Availability of vaccines ranged from 90.6% for PCV-13 to 93.8% for BCG and Polio vaccines. However, 96% of primary facilities had all six child vaccines on the day of the assessment visit correct arrangement of vaccines in the refrigerator, the functionality of freeze tags and the availability of immunization cards were 93.8%. Only 87.5% of all primary healthcare facilities visited had a national guideline for immunization services. The Status of daily temperature chart updating was 56.3%. The majority (87.5%) of primary healthcare facilities’ time of vaccine opening was not written on the vial whereas the shortage of staff to carry out immunization services was 78.1%. About 81.3% of the health facilities visited had no reliable transport for immunization outreach activities. Only 65.6% of health facilities had a different poster for immunization services. In addition, 28.1% of health facilities visited had no map for the catchment area, where 56.3% of health facilities had no tall sheet and 25% of health facilities do not practice health talk before immunization services. More than half (56.3%) of health facilities’ site space was not sufficient to accommodate clients (Table 3).
Table 3: Proportional of primary healthcare facilities’ response on availability of immunization services readiness items in the border district council, Kagera Region (n=32)
Variable
|
Availability n (%)
|
Yes
|
No
|
Items for cold chain
|
|
|
Functional refrigerator
|
32(100)
|
0
|
Vaccine carrier box
|
31(96.9)
|
1(3.1)
|
A power source (solar /generator/gases)
|
32(100)
|
0
|
Functional Thermometer and freeze tag
|
30(93.8)
|
2(6.3)
|
Updated daily temperature chart
|
18(56.3)
|
14(43.8)
|
Refrigerator temperature 20C and 80C in the previous month
|
32(100)
|
0
|
All vaccine vials placed correctly arranged inside the refrigerator
|
30(93.8)
|
2(6.3)
|
Time of vaccine opening written on the vial
|
4(12.5)
|
28(87.5)
|
Disposable syringes
|
32(100)
|
0
|
Safety box
|
32(100)
|
0
|
Logistic items
|
|
|
Sufficient staff offering immunization
|
7(21.9)
|
25(78.1)
|
Means of transportation to outreach activities
|
5(15.6)
|
27(84.4)
|
Presence of posters in the reception/nursing station
|
21(65.6)
|
11(34.4)
|
Availability of map of catchment area
|
23(71.9)
|
9(28.1)
|
Tally sheets
|
14(43.8)
|
18(56.3)
|
Summary forms
|
31(96.9)
|
1(3.1)
|
BCG
|
30(93.8)
|
2(6.2)
|
Polio
|
30(93.8)
|
2(6.3)
|
Measles and Rubella
|
32(100)
|
0
|
Pentavalent
|
32(100)
|
0
|
Rotavirus
|
32(100)
|
0
|
Pneumococcal Vaccine (PCV 13)
|
29(90.6)
|
3(9.4)
|
Availability of blank immunization cards
|
30(93.8)
|
2(6.2)
|
Health talk before immunization
|
24(75)
|
8(25)
|
Space sufficient for clients
|
14(43.8)
|
18(56.3)
|
Do you have the national guidelines for child vaccinations available in this service area today?
|
28(87.5)
|
4(12.5)
|
Do you have any other guidelines for child vaccinations available in this service area today
|
21(65.6)
|
11(34.4)
|
Data presented in frequency and percentage
Percentage of vaccines availability among primary healthcare facilities assessed in border district councils, Kagera Region (n=32)
Among all facilities that were visited, the availability of vaccines is quite good, ranging from 90.6 per cent having PCV-13 to 93.8 per cent of facilities having BCG and Polio vaccines. However, 96 per cent of facilities had all six child vaccines on the day of the assessment visit (Figure 1).
Status of childhood routine immunization services readiness in primary healthcare facilities assessed in border district councils, Kagera region (n=32)
Of the 32 health facilities, 90.6% of the facilities were ready to provide immunization services and 9.4% were not ready. The cut of point used was 70% adapted from Adamu et al, 2020 (Figure 2).
Socio-demographic characteristics of children and their caregivers/mothers in border district councils, Kagera Region (n=32)
A total of 250 caregivers/mothers of children aged between 0-24 months old were interviewed, Of the total 250 children, 140(56%) were male and 110 (44%) were female. The majority 140 (56%) of the children were aged below 12 months, about 82.8% of them were born at health facilities and 18(7.2%) were born at home (table 4). The majority 224(89.6%) of respondents were mothers, more than 149(59.6%) of mothers were aged between 25 to 34 years and most of them were educated to primary level by 147(58.8%).In addition, 219 (87.6%) of caregivers/mothers were married and 147(58.8%) were employed. Also, it was found that 121(48.4%) of the respondent used less than 30 minutes to reach health facilities. Approximately 244 (97.6%) of the respondent were aware of immunization and more than half 176(70.4) received immunization information from a healthcare practitioner (Table 5).
Table 4: Socio-demographic characteristics of children in border district councils of Kagera Region, n=250
Variable
|
Frequency(n)
|
Per cent (%)
|
Child
|
|
|
Age group ( Years )
|
|
|
|
<1
|
140
|
56
|
|
1-2
|
110
|
44
|
Sex of child
|
|
|
Male
|
127
|
50.8
|
Female
|
123
|
49.2
|
Place of delivery of child
|
|
|
Health facilities
|
231
|
92.4
|
Home
|
19
|
7.6
|
Table 5: Socio demographic characteristics of caregivers/mothers in border district councils of Kagera Region, n=250
Variable
|
Frequency(n)
|
Per cent (%)
|
Age group
|
|
|
15-24
|
79
|
31.6
|
25-34
|
149
|
59.6
|
35 and above
|
22
|
8.8
|
Sex
|
|
|
Male
|
26
|
10.4
|
Female
|
224
|
89.6
|
Relationship with a child
|
|
|
Mother/Father
|
236
|
94.4
|
Grandparent
|
14
|
5.6
|
Marital status
|
|
|
Single
|
10
|
4.0
|
Married
|
219
|
87.6
|
Cohabited
|
21
|
8.4
|
Employment status
|
|
|
Yes
|
147
|
58.8
|
No
|
103
|
41.2
|
Level of education for caregivers/mothers
|
|
|
Informal
|
28
|
11.2
|
Primary
|
150
|
60.0
|
Secondary and above
|
72
|
28.8
|
Time to reach a health facility
|
|
|
Less than 30 mins
|
121
|
48.4
|
31 - 60 mins
|
104
|
41.6
|
61 and above
|
25
|
10.0
|
Awareness
|
|
|
Aware
|
244
|
97.6
|
Not aware
|
6
|
2.4
|
Source of immunization information
|
|
|
Friends
|
14
|
5.6
|
Health care practitioner
|
176
|
70.4
|
Media
|
60
|
24.0
|
The proportion of caregivers/mothers responses to knowledge questions on immunization in border district councils of Kagera Region (n=250)
Out of the 250 caregivers/mothers, 194 (77.6%) knew correctly the purpose of vaccinating their children was to prevent diseases, whereas 217(86.8%) of respondents had no alternative means to prevent vaccine-prevented diseases apart from vaccines. More than half of them 145(58%) reported that their children complete the immunization schedule at 18 months and 129 (51.6%) were able to mention types of vaccines and diseases prevented by childhood vaccines (Table 6).
Table 6: Proportion of caregivers/mothers’ responses to knowledge questions on immunization in border District councils, Kagera Region (n=250)
Items about immunization
|
Frequency
|
Per cent
|
At what age should a child complete immunization
|
|
|
Before one year
|
65
|
26.0
|
18 months
|
145
|
58.0
|
Don't know
|
40
|
16.0
|
What is the purpose of immunization?
|
|
|
Make child brilliant
|
8
|
3.2
|
prolongs life
|
48
|
19.2
|
Prevent disease
|
194
|
77.6
|
Is there an alternative to preventing vaccine-preventable diseases
|
|
|
Yes
|
33
|
13.2
|
No
|
217
|
86.8
|
Can you mention 2 types of vaccines or diseases that your child prevented by the vaccine received?
|
|
|
Mentioned
|
129
|
51.6
|
Not able to mention
|
121
|
48.4
|
Overall Level knowledge of caregivers/mothers on immunization in border District councils, Kagera Region (n=250)
More than half 58% of caregivers/mothers had adequate knowledge and 42% had inadequate knowledge using a cut-off point of 50% (Figure 3).
Uptake of childhood routine immunization services among caregivers/mothers in border district councils, Kagera Region (n=250)
Out of the 250 children, 183 (73.2%) were fully immunized and 67 (26.8%) were partially immunized, this was assessed from the child immunization card (Figure 4 )
Childhood routine immunization uptake by considering children’s age in border District councils, Kagera Region (n=250)
The result from this study shows that the trend of immunization uptake tends to be reduced as a child grows, where at the age of one month all children received full immunization whereas at 18 and above only 56.7 per cent were fully immunized (Table 7 ).
Table 7: Shows childhood routine immunization uptake by considering children’s age among caregivers/mothers in border district councils, Kagera Region (n=250)
Variable
|
Immunization uptake
|
Age(months)
|
Fully immunized n (%)
|
Partially immunized n (%)
|
1
|
8(100)
|
0
|
2
|
12(63.2)
|
7(36.8)
|
3
|
19(82.6)
|
4(17.4)
|
4 -8
|
56(98.3)
|
11(1.7)
|
9-17
|
59(72)
|
23(28)
|
18 and above
|
29(56.7)
|
22(43.3)
|
Childhood routine immunization uptake among caregivers/mothers between border District councils in Kagera Region n=250
Out of the four border District councils visited, D1 had good full immunization uptake of 87 per cent compared to all other district councils. The D2, D3, and D4 District councils had a significant number of children who are partially immunized in the community by 27 per cent, 36 per cent and 35 per cent respectively (Table 8)
Table 8: Shows childhood immunization uptake among caregivers/mothers in border District councils Kagera Region (n=250)
|
Full immunized n (%)
|
Partially immunized n (%)
|
p-value
|
District councils
|
|
|
0.03*
|
D1
|
54(87)
|
8(13)
|
|
D2
|
38(73)
|
14(27)
|
|
D3
|
44(64)
|
20(36)
|
|
D4
|
47(65)
|
25(35)
|
|
Asterisk (*) means the significant different (p<0.05).D=Represent name of district councils visited
Association between socio-demographic characteristics of children, their caregivers/mothers and childhood routine immunization uptake.
The result shows, dependently, level of education, place of delivery and facility readiness were associated with the uptake of childhood routine immunization services (p<0.05). Proportionally, caregivers/mothers who were educated to secondary level and above, those children who delivered to healthcare facilities, caregivers/mothers aware of immunization and those who received service from ready health facility to provide the immunization services were fully immunized by 76.4 per cent, 75.3 per cent,74.4 per cent and 74.1 per cent respectively. The age group, time consumed to reach health facilities and employment and knowledge were not associated with the uptake of immunization services (Table 9).
Table 9: Association between socio-demographic characteristics of caregivers/mothers, health facility readiness and uptake of childhood routine immunization in border District councils, of the Kagera Region n=250
Background characteristics
|
Immunization uptake
|
P-value
|
Full immunized n (%)
|
Partially immunized n (%)
|
Education level
|
|
|
0.04*
|
Informal
|
15(53.6)
|
13(46.4)
|
|
Primary school
|
113(75.3)
|
37(24.7)
|
|
Secondary and above
|
55(76.4)
|
17(2.6)
|
|
Place of delivery
|
|
|
0.01*
|
Health facilities
|
174(75.3)
|
57(24.7)
|
|
Home
|
9(55.6%)
|
10(44.4)
|
|
Facility readiness
|
|
|
|
Ready
|
172(74.1% )
|
66(25.9% )
|
F0.04*
|
Not ready
|
11(61.1%)
|
1(38.9%)
|
|
Time consumed to reach health facility (Minutes)
|
|
|
0.66
|
Less than 30
|
91( 75.2)
|
30(24.8)
|
|
31-60
|
73(70.1)
|
31(29.9)
|
|
61and above
|
19(76)
|
6(24)
|
|
Employment
|
|
|
0.19
|
Yes
|
103(70.1)
|
44(29.9)
|
|
No
|
80(77.6)
|
23(22.3)
|
|
Age group
|
|
|
0.41
|
15-24 years
|
56(70.8)
|
23(29.2)
|
|
25-34 years
|
113(75.8)
|
36(24.2)
|
|
35 and above
|
14(63.6)
|
8(36.4)
|
|
Knowledge
|
|
|
|
Adequate
|
107(73.8)
|
38(26.2)
|
0.88
|
Inadequate
|
76(72.4)
|
29(27.6)
|
|
Asterisk (*) means the significant relation (p<0.05), F=Fisher’s exact test
Regression results
In logistic regression, the significant determinants that independently remained related to immunization uptake were facility readiness and place of delivery. Where the odds of caregivers who received immunization services from not-ready health facilities being fully immunized was 0.157 less likely compared to the ready facilities (AOR=0.157,[0.021-1.231]). On the other hand, the odds of children being fully immunized were reduced among the caregivers/mothers delivered at home (AOR=0.37, [0.136-1.1008] (Table 10).
Table 10: Logistic regression for determinants of childhood routine immunization uptake among caregivers/mothers in border district councils, of the Kagera Region n=250
|
Unadjusted
|
Adjusted
|
Variable
|
OR(95%CI)
|
P-value
|
AOR(95%CI)
|
P-value
|
Facility readiness
|
|
|
|
|
Ready
|
1
|
|
1
|
|
Not ready
|
0.148(0.019-1.134)
|
0.04
|
0.157 (0.021-1.231)
|
0.03*
|
Place of delivery
|
|
|
|
|
Health facilities
|
1
|
|
1
|
|
Home
|
0.295(0.114-0.762)
|
0.01
|
0.37(0.136-1.008)
|
0.04*
|
Mother’s education level
|
|
|
|
|
Informal
|
1
|
|
1
|
|
Primary school
|
2.804(1.117-7.040)
|
0.03
|
2.143 (0.819-5.603)
|
0.12
|
Secondary and above
|
1.059(0.548-2.047)
|
0.86
|
1.175 (0.554-2.112)
|
0.65
|
Mother’s employment
|
|
|
|
|
No
|
1
|
|
1
|
|
Yes
|
1.486(0.83-2.661)
|
0.18
|
1.37 (0.736-2.549)
|
0.32
|
AOR, Adjusted Odds Ratio, CI, Confidence Interval, OR, Odds Ratio. Asterisk (*) means the significant effect (p<0.05).